Integration of Primary Care and Mental Health Services - Quality Measures

Suggested short list - measurement strategies for integration of primary care and mental health P. Knapp, R. McCarron, T. Conway, J. Jones, J. Langley 7/23/2010

INTEGRATION OF PRIMARY CARE AND MENTAL HEALTH SERVICES - QUALITY MEASURES Population for Numerator/ Name of the measure: Area Denominator Data Gathering Plan Goal Measure sample population or target population for (comments below) specific measures

k 1. s Count of A count of the active Number of all active SMI clients On the last workday of each month, count the At least i r

clients SMI clients shared by currently in the microsystem. number of active SMI clients shared by MH and 100 t a

MH and PC PC partnership as of that date clients s t n e

l Risk The percentage of Number of active SMI clients On the last workday of each month, count all 95% c

f Behavior active SMI clients screened for smoking, ETOH, & active SMI clients who have been seen within the o

Screening who have been drug use at their last encounter last 6 months and were screened for smoking, n

o recently screened for or within the last 6 months/ ETOH, and drug use at their last encounter. i t

a risk behaviors (e.g. target population (All active SMI Then divide this number by the current size of c i

f CAGE, audit) clients) the target population (measure 1) and multiply by i t

n 100. e

d 3. a. CVD/DM The percentage of Number of all SMI clients On the last workday of each month, count all 95% I Risk active SMI clients screened for BP, BMI, and waist active SMI clients who have been screened for Screening who have been circumference in the last 6 BP, BMI, and waist circumference in the last 6 (without waist recently screened for months/ target population (All months. Then divide this number by the current circumference) CVD/DM risk (BP, active SMI clients) size of the target population (measure 1) and 3. b. CVD/DM BMI, and waist multiply by 100. Risk circumference) Screening

4. Screening for Percentage of active Number of clients at risk for On the last workday of each month, count all SMI 85% DM (& hyper- SMI clients on CVD/DM (currently on AAPs, clients who are at-risk for CVD/DM (currently on lipidemia) psychotropic meds SSRIs, and/or BMI>25) with AAPs, SSRIs, and/or BMI>25) who have had that pose risk for fasting glucose and lipid panel in both a fasting glucose test and a lipid panel in CVD/DM who have the last 12 months (#2)/ the last 12 months. Also, count all SMI clients been screened for Number of active SMI clients on who are at-risk for CVD/DM (currently on AAPs, CVD/DM risk (fasting AAPs, SSRIs, and/or BMI > 25 SSRIs, and/or BMI>25). Then divide the first glucose and lipid number by the second and multiply by 100. panel)

1 Suggested short list - measurement strategies for integration of primary care and mental health P. Knapp, R. McCarron, T. Conway, J. Jones, J. Langley 7/23/2010

Population for Numerator/ Name of the measure: Area Denominator Data Gathering Plan Goal Measure sample population or target population for (comments below) specific measures l

o 5. Blood Percentage of SMI Number of SMI clients who have On the last workday of each month, count all SMI 70% r t

n Pressure in clients whose last BP a documented BP < 140/90 at clients who have a documented BP < 140/90 o

c Control < 140/90 their last visit (within the last 12 (within the last 12 months) .Then divide that

d months)/ target population number by the number of SMI clients in the n a

target population and multiply by 100. k s i r

h t l a e h

, s e r u s a e m

e r o C

s Percentage of SMI Number of clients with DM and > On the last workday of each month, count all SMI 80% n 6. Statin use o

i clients with DM and > 40 yrs or with CAD risk factors, clients with DM and > 40 yrs or with CAD risk t

a 40 yrs or with CAD (#4) or CAD & are on a statin/ factors, (#4) HTN or CAD & are on a statin. Also, c i

d risk factors, (#4) or Number of clients with DM and > count all SMI clients with DM and > 40 yrs or with e CAD & are on a statin 40 yrs with CAD risk factors, (#4) CAD risk factors, (#4) HTN or CAD. Then divide M

d HTN or CAD the first number by the second and multiply by e t 100. a c i 7. ACE inhibitor Percentage of SMI Number of SMI clients with DM On the last workday of each month, count all SMI 80% d

n clients with DM and and CAD, HTN, or clients with DM and CAD, HTN, or I use CAD, HTN, or microalbuminuria (#1) on an microalbuminuria on hydroclorothiazide, an ACE microalbuminuria ACE inhibitor, or ARB/ inhibitor or ARB. Also, count all SMI clients with who are on an ACE Number of SMI clients with DM DM and CAD, HTN, or microalbuminuria. Then Inhibitor (ARB) and CAD, HTN, or divide the first number by the second and microalbuminuria multiply by 100.

Population for Numerator/ Name of the measure: Area Denominator Data Gathering Plan Goal Measure sample population or target population for (comments below) specific measures 8. Aspirin use Percentage of SMI Number of the SMI clients with On the last workday of each month, count all SMI 80% clients with DM DM and a > 10% 10 year risk for clients with DM and who have a > 10% 10 year and/or established MI and who are on daily ASA/ risk for MI and who are on daily ASA. Also, count vascular disease Number of the SMI clients with all SMI clients with DM and a > 10% 10 year risk (PVD, CHD) or CAD DM and a > 10% 10 year risk for for MI. Then divide the first number by the on an antithrombotic MI second and multiply by 100. (ASA)

s 9. Smoking Percentage of SMI Number of current SMI smokers On the last workday of each month, count all SMI 85% n o

i cessation clients who smoke who were counseled to quit at who are current smokers and were counseled to t

n counseling and received their last visit/ quit at their last encounter. Also, count all SMI e v

r cessation counseling All SMI clients who currently clients who are current smokers. Then divide the e t at their last encounter smoke first number by the second and multiply by 100. n I

r 10. Substance Percentage of SMI Number of current SMI with co- On the last workday of each month, count all SMI 85% e Abuse clients with SUD with occurring SUD with Tx plan or with co-occurring SUD who have Tx plan or h t

O treatment treatment plan or referral at last visit/ referral at their last encounter. Also, count all referred to SUD All SMI clients with co-occurring SMI clients with co-occurring SUD. Then divide program SUD the first number by the second and multiply by 100. 11. Self- Percentage of active The number of active SMI clients On the last workday of each month, count the 80% management SMI clients with a with documented self- number of SMI clients who have documented goal setting documented self- management goals in the last 12 self-management goals set with a clinician in the management goal months/ the total number of SMI past 12 months. At the same count the number within the last 12 clients in the target Population of clients in the target Population. Then divide months the first number by the second and multiply by 100. 12. Shared Care Percentage of active Number of SMI clients with a On the last workday of each month, count the 90% Plan SMI clients with a shared care plan (shared by PC number of SMI clients who have a shared care shared care plan: and MH)/ the total number of plan (shared by PC and MH). At the same count Primary Care & SMI clients in the target the number of clients in the target Population. Mental Health population Then divide the first number by the second and multiply by 100.

Population for Numerator/ Name of the measure: Area Denominator Data Gathering Plan Goal Measure sample population or target population for (comments below) specific measures e r 13. Receive Percentage of SMI Number of MH clients with a On the last workday of each month, count the 80% a

C clients in target documented primary care number of SMI clients who have a documented

on-going y

r primary care population seen at provider at the “shared” site./ Primary Care Provider. At the same count the a MH who have a target population (All SMI clients) number of clients in the target Population. Then m i

r documented PCP at divide the first number by the second and P the “shared” site multiply by 100. o t 14. Referred Percentage of SMI Number of MH clients with On the last workday of each month, count the 60% h t l clients to clients in target referral to primary care in last number of SMI clients who were referred to a

e primary care population seen at month who showed for appt in primary care services and were seen by their H

l MH who were also primary care/ Number of MH PCP in the last month. At the same count the a t seen at primary care clients with referral to primary number of clients in the target Population who n

e as part of a referral to care in the last month were referred to primary care in the last month. M primary in last month Then divide the first number by the second and m

o multiply by 100. r f

s l a r r e f e R

H 15. % referred to Percentage of clients Number of clients in the target On the last workday of each month, count the 90% M MH services in the target population who have a plan for number of SMI clients who have a plan for MH o t population identified MH treatment in primary care or treatment in primary care or were referred to C

P by PCP with SMI who were referred by primary care to mental health services by primary care in the last

m have a plan for MH mental health services in the last month. At the same count the number of clients o

r treatment in primary month/ target population (All SMI in the target population. Then divide the first f

l care or were referred clients) number by the second and multiply by 100. a

r by primary care to r e

f mental health e services in the last R month. 16. Referred to Percentage of SMI Number of MH clients with On the last workday of each month, count the 60% MH and kept clients in target referral to mental health in last number of SMI clients who were referred to appt population seen at month who showed for appt in mental health services by primary care and were PC who were also mental health/ Number of MH seen by their MH clinician in the last month. At seen at mental health clients with referral to mental the same count the number of clients in the as part of a referral to health in the last month target Population who were referred to mental mental health in last health services in the last month. Then divide the month first number by the second and multiply by 100. 4 Suggested short list - measurement strategies for integration of primary care and mental health P. Knapp, R. McCarron, T. Conway, J. Jones, J. Langley 7/23/2010

#1 ADA guidelines comingled with the 2004 consensus report #2 Separate outcomes – fasting for > 8 hours. Consistent with JNC (either 120 mmHg for pre-HTN or 140 mmHg) cut-off of 130 mmHg for those with DM or CRI #3 Acceptable established risk factors per Metabolic Syndrome 5 factor Risk guide #4 DM with HTN or microalbuminuria only (grad A, per AHA and ADA). With that said, in the interest of simplicity, we may want to omit this if we have too many metabolic measures.